AHA Updates CPR, Emergency Cardiovascular Care Guidelines

Recommendations Focus on Bystanders, Clinicians

More than 326,000 people experience cardiac arrest outside of a hospital setting each year, and about 90 percent of them die -- often because bystanders don't know how to start CPR or are afraid they'll do something wrong.

That's why it's important for family physicians to review the "2015 American Heart Association (AHA) Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (ECC)." The update was recently published as a series of articles in Circulation: Journal of the American Heart Association.

This 2015 update reaffirms proven CPR techniques while enhancing previous recommendations, such as those for the appropriate rate and depth of chest compressions. A key feature of the new guidelines is recognition that health care professionals and bystanders in the community have essential and complementary roles in providing CPR and ECC.

Moreover, said Clifton Callaway, M.D., Ph.D., chair of the AHA's Emergency Cardiovascular Care committee, in a news release,(www.prnewswire.com) "The 2015 update calls for integrated systems of care that participate in continuous quality improvement and that provide a common framework for both community and health care-based resuscitation systems. We must create a culture of action that benefits the entire community in which it operates, inside and outside the hospital setting."

Story Highlights

A 2015 update from the American Heart Association (AHA) reaffirms proven CPR techniques while enhancing previous recommendations, such as those for the appropriate rate and depth of chest compressions.

A key feature of the new guidelines is recognition that health care professionals and bystanders in the community have essential and complementary roles in providing CPR and emergency cardiovascular care.

The AHA is providing this year's guidelines update in three forms: the full guidelines update; a highlights document that summarizes key points; and a mobile-friendly, searchable website that features all related scientific findings.

Updated Guidelines for Health Care Professionals

For almost 50 years, the AHA's CPR and ECC guidelines have been used to train millions in CPR, first aid and advanced cardiovascular care around the world. These guidelines are based on an international evaluation process that involved hundreds of resuscitation scientists and experts worldwide who evaluated thousands of peer-reviewed publications for the best methods to treat cardiovascular emergencies -- particularly cardiac arrest.

The addition of upper limits for the recommended rate and depth of chest compressions. Specifically, compressions should be performed at a rate of 100-120 per minute and to a depth of at least 2 inches, avoiding excessive depths greater than 2.4 inches.

Targeted temperature management to prevent brain degradation during post-cardiac arrest care. New evidence shows that a wider range of temperatures are acceptable, and health care professionals should select a temperature between 32 degrees Celsius and 36 degrees Celsius and maintain it for at least 24 hours.

A recommendation to simultaneously perform various CPR steps. Clinicians are encouraged to simultaneously perform CP process steps such as checking for breathing and pulse to reduce the time to first chest compression.

A lack of evidence regarding routine neonatal intubation. AHA researchers found insufficient evidence to recommend routinely intubating newborns with poor breathing and muscle tone associated with meconium ingestion. Instead, the new recommendation is to begin CPR under a radiant warmer to get oxygen to the infant faster.

Additional Notes for Family Physicians

Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News the new guidelines continue to focus on chest compressions more than on ventilation.

"Chest compressions should be initiated as quickly as possible, so when assessing an unconscious patient, family physicians should perform steps simultaneously to reduce the time needed," she said. "Pauses in compressions to perform shocks, provide breaths or to reassess the patient should also be as brief as possible."

Because there is limited evidence about CPR in children, Frost said the algorithms are essentially the same for kids as for adults to simplify the information. Compressions in these younger patients should be performed at a rate of about 100-120 per minute and to a depth of about 2 inches.

Furthermore, in the absence of an advanced airway, the compression-to-breath ratio should be 30:2 for a lone rescuer and 15:2 with a second rescuer, with effective compressions being far more critical in most cases than ventilation, she added.

The AHA is providing this year's guidelines update in three forms:(eccguidelines.heart.org) the full guidelines update; a highlights document that summarizes key points; and a mobile-friendly, searchable website that includes all related scientific findings.

"Family physicians will often be the team leader in a code situation, so we should be comfortable with the algorithms and ensure that our staff members are aware of their role and have adequate training," Frost said.